A nurse is working with a local group that is in the process of reducing the use of pesticides in community gardens. The nurse should identify that the group is in which of the following stages of change?

A. Disseminated intravascular coagulation: DIC is a rare, life-threatening condition associated with severe complications such as placental abruption or amniotic fluid embolism. The client currently has no signs or risk factors indicating DIC.

B. Preeclampsia: Preeclampsia is characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. This client’s blood pressure is within normal limits, so preeclampsia is not an immediate concern at this time.

C. Placenta previa: Placenta previa involves implantation of the placenta over the cervical os, which would present with painless bright-red vaginal bleeding. The client’s lower back pain and pinkish discharge, along with contractions, do not suggest placenta previa.

D. Sepsis: The client has a fever (38.4° C / 101.1° F) and reports vaginal discharge, which could indicate an intrauterine or urinary tract infection. Infections during pregnancy can rapidly progress to sepsis, so the client is at increased risk and requires close monitoring.

E. Preterm prelabor rupture of membranes (PPROM): The client is experiencing uterine contractions at 33 weeks of gestation with pinkish vaginal discharge. These findings, along with her history of preterm birth, place her at risk for PPROM and preterm labor.

F. Seizures: Seizures are primarily associated with eclampsia or epilepsy. The client has no history of seizure disorder or signs of preeclampsia, making this complication unlikely at this time.

A. Weigh the client before and after the procedure: Monitoring the client’s weight before and after paracentesis provides an objective measure of the volume of fluid removed. This helps evaluate the effectiveness of the procedure and assess for complications such as fluid shifts or hypotension.

B. Administer a low-volume hypertonic enema the night before the procedure: Bowel cleansing is not required for paracentesis, as the procedure targets the peritoneal cavity, not the gastrointestinal tract. Administering an enema could cause unnecessary discomfort without benefit.

C. Ensure the client has a full bladder just prior to the procedure: A full bladder increases the risk of puncture during paracentesis. Clients are typically advised to void before the procedure to minimize the risk of bladder injury.

D. Place the client in a side-lying position for the procedure: Paracentesis is usually performed with the client in a sitting position, leaning slightly forward, or in a supine position with the head of the bed elevated. Side-lying positioning does not provide optimal access to the fluid-filled peritoneal cavity.